NextBlue Medically Unlikely Edits (MUE) Claims Configuration Update

NextBlue is informing our provider community that we are working to update the Medically Unlikely Edits (MUE) claims configuration.

NextBlue will pay for the number of units of service that are considered medically likely based on the MUE value assigned to the procedure code, and any units exceeding that limit will be denied on the claim; essentially, the provider will be reimbursed for the maximum allowable units defined by the MUE for that specific service on a single date of service. This change reflects updates to align with the MUE standards.

The updated configuration will go into effect on March 13, 2025. Claims related to the MUE configuration that were received from Jan. 1, 2025, to March 12, 2025, will be reprocessed under the updated configuration.

Please follow the appeal process for units exceeding the MUE allowance.

After March 13, 2025, please allow 60 days for NextBlue to reprocess the claims impacted. If you feel that you have claims that have not been corrected within the next 60 days, reach out to our Provider Service Center at 844-753-8039.